Salmeterol
| (sal-MEET-ah-rahl) |
| Serevent, Serevent Diskus |
| Class: Bronchodilator/sympathomimetic |
Action Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation.
Indications Maintenance treatment of asthma and prevention of bronchospasm with reversible obstructive airway disease; prevention of exercise-induced bronchospasm; maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis).
Contraindications Cardiac tachyarrhythmias.
Route/DosageAsthma/Bronchospasm
ADULTS & CHILDREN ³ 12 YR: Inhalation 2 inhalations twice daily, » 12 hrs apart. ADULTS & CHILDREN ³ 4 YRS FOR INHALATION POWDER: Inhalation 1 inhalation (50 mcg) twice daily, » 12 hrs apart.
Exercise-Induced Bronchospasm
ADULTS & CHILDREN ³ 12 YR: Inhalation 2 inhalations at least 30 to 60 mins before exercise; additional doses should not be used for up to 12 hrs. ADULTS & CHILDREN ³ 4 YRS FOR INHALATION POWDER: Inhalation 1 inhalation ³ 30 mins before exercise; additional doses should not be used for up to 12 hrs.
COPD
ADULTS: Inhalation 2 inhalations (42 mcg) twice daily, » 12 hrs apart.
InteractionsDiuretics: ECG changes and hypokalemia associated with these diuretics may worsen with coadministration. MAO inhibitors, tricyclic antidepressants: May increase cardiovascular effects of salmeterol.
Lab Test Interferences None well documented.
Adverse ReactionsCV: Tachycardia; palpitations. CNS: Tremor; anxiety; malaise; fatigue; dizziness; vertigo; nervousness; headache. EENT: Rhinitis; throat dryness/irritation. GI: GI distress; nausea; vomiting; diarrhea. META: Hyponatremia. RESP: Cough; paradoxical bronchospasm; upper respiratory tract infection; nasopharyngitis; nasal cavity/sinus disease; sinus headache; lower respiratory tract infection; allergic rhinitis; laryngitis; tracheitis/bronchitis. OTHER: Joint/back pain; muscle cramp/contraction; myalgia/myositis; muscular soreness; giddiness; influenza; viral gastroenteritis; urticaria; dental pain; malaise/fatigue; eruption; dysmenorrhea.
PrecautionsPregnancy: Category C. Children: Not recommended for children < 12 yr. Acute asthma seizures: Do not use to treat acute symptoms. Cardiovascular disease: Use with caution in patients with cardiovascular disease, toxic symptoms may occur. Excessive use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Hypersensitivity: Allergic reactions can occur after administration. Hypokalemia: Decreases in potassium levels may occur.
| PATIENT CARE CONSIDERATIONS |
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Administration/Storage- This medication is available only in a pressurized, metered-dose inhalation aerosol unit.
- Use only with supplied aerosol actuator. Do not use the actuator with other medications.
- Do not use a spacer with the inhalation powder. Keep the device dry and never wash the mouthpiece or any part of the device.
- Store at room temperature. The therapeutic effects are reduced when cold; the container may explode if exposed to temperatures above 120°F. Protect from freezing and direct sunlight.
- Store canister with nozzle end down.
- Do not puncture or incinerate canister.
- Shake well before using.
Assessment/Interventions- Obtain patient history.
- Closely monitor patients with a history of arrhythmias, seizures or peptic ulcers.
- Obtain baseline pulmonary function tests.
- Note frequency and severity of asthma attacks.
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Patient/Family Education- Instruct patient on the proper storage and use of the aerosol inhaler, referring patient to the instruction sheet included with the medication.
- Advise patient not to exceed the recommended dosage and frequency of the medication.
- Warn patient not to alter the dose or discontinue the medication without consulting the health care provider.
- Instruct patient to check with his/her physician first before taking any otc or prescription medications.
- Emphasize to patient that this medication is NOT to be used for the treatment of acute or deteriorating asthma.
- Inform patient that this medication is NOT a substitute for other medications he/she may be on, including oral or inhaled corticosteroids.
- Instruct patient to call the health care provider if the medication seems to be less effective.
- Alert patient that this medication may be used 30 to 60 mins BEFORE exercise to reduce or prevent exercise-induced bronchospasm.
- Have patient report any serious side effects to the health care provider, including: Tachycardia, palpitations, tremors, change in personality, insomnia, shortness of breath and stomach cramps.
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